Provider Demographics
NPI:1295567725
Name:HARDWELL, ALIYAH T
Entity type:Individual
Prefix:
First Name:ALIYAH
Middle Name:T
Last Name:HARDWELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7343 HIGHWAY 79
Mailing Address - Street 2:
Mailing Address - City:EMERSON
Mailing Address - State:AR
Mailing Address - Zip Code:71740-9309
Mailing Address - Country:US
Mailing Address - Phone:870-833-1109
Mailing Address - Fax:
Practice Address - Street 1:7343 HIGHWAY 79
Practice Address - Street 2:
Practice Address - City:EMERSON
Practice Address - State:AR
Practice Address - Zip Code:71740-9309
Practice Address - Country:US
Practice Address - Phone:870-833-1109
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-14
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program